The American journal of the medical sciences最新文献

Asthma is a complex clinical syndrome characterized by airway inflammation that can cause variable, usually reversible airway obstruction and bronchial hyperreactivity. This illness has a spectrum from intermittent to persistent that has mild, medium or severe intensity. As our understanding of the underling inflammatory pathway grows, so too does our catalogue of advanced treatments (such as monoclonal antibodies), opening the path for treatment individually curated for patients. The current approved therapies are directed against IgE, interleukin (IL)-5, IL-5 receptor, IL-4 receptor subunit-α and most recently thymic stromal lymphopoietin (TSLP). These therapies all have demonstrated efficacies that make them variably effective in patients with moderate to severe persistent disease. More recently, other inflammatory molecules have been therapeutically targeted and are currently under clinical investigation for future potential use. However, a significant concern remains: the high financial costs for these advanced therapies continues to pose a significant burden both to patients and the healthcare system. Novel uses of long-acting bronchodilator-corticosteroids inhalers may reduce the use of highly priced biologics in many patients with comparatively less severe disease. Furthermore, the variability in patient response demands further research into to identify which patients will best respond to which specific therapy.

Objective: To conduct a meta-analysis of the factors influencing sarcopenia in patients with Crohn's disease and provide evidence-based findings for early clinical detection and prevention.

Methods: The study was registered on PROSPERO(CRD42023470300). A systematic review was performed on literature pertaining to sarcopenia in patients with Crohn's disease utilizing eight Chinese and English databases, which consist of CNKI, Wanfang, VIP, CBM, PubMed, Web of Science, Embase, and The Cochrane Library. The search was carried out from the inception of each database until October 8, 2023. Data analysis was carried out using the Stata 14.0 software.

Results: A total of 603 Chinese and English literature sources were reviewed, and following the application of the inclusion and exclusion criteria, 9 articles were selected. These 9 articles take into account a total of 22 factors that may influence the occurrence of sarcopenia in Crohn's disease patients. The results of the meta-analysis demonstrate that gender (OR=5.49, 95% CI [2.08,14.51]), BMI (OR=0.77, 95% CI [0.62,0.95]), age (OR=1.03, 95% CI [1.01,1.05]), and low albumin levels (OR=1.08, 95% CI [1.01,1.15]) have significant impacts on the emergence of sarcopenia in patients with Crohn's disease.

Conclusions: The occurrence of sarcopenia in Crohn's disease patients is mainly influenced by gender, BMI, age, and low albumin levels. Additional factors that may influence the condition require further research to verify.

Background: Chronic kidney disease (CKD) is a major cause of human mortality and cardiovascular disease (CVD)-related death. Niacin can treat dyslipidemia and can lower overall cardiovascular event incidence and mortality rates. The present study was designed to clarify the link between dietary consumption of niacin and cardiovascular mortality.

Methods: This study enrolled subjects ≥18 years of age from the National Health and Nutrition Examination Survey 2009-2014 and excluded any individuals for whom data regarding their CKD status, dietary niacin intake, or other covariate information was unavailable. Relationships between dietary niacin intake levels and overall or CVD-related mortality among these CKD patients were assessed using univariate and multivariate Cox regression analyses.

Results: The study included 1,798 subjects and recorded 514 and 186 instances of all-cause and cardiovascular death, respectively. Males comprised 51.8% of the study cohort, and the mean age of these subjects was 65. Cox proportional hazard model analyses revealed no relationship between dietary niacin intake and all-cause or cardiovascular death risk among the overall CKD patient population (P > 0.05). However, in age-stratified analyses, those subjects <60 years of age exhibiting the highest levels of dietary niacin consumption (≥ 38 mg/day) were found to face a significantly higher risk of all-cause mortality, and this association remained intact in sensitivity analyses.

Conclusion: These results do not support any link between the dietary intake of niacin and all-cause or cardiovascular mortality risk among patients with CKD. Age and niacin intake exhibited a significant interaction related to all-cause mortality.

Background: Depression has a high prevalence among patients undergoing coronary artery bypass grafting (CABG). However, there is a scarcity of literature on the association between preoperative depression and CABG outcomes. This study aimed to explore the effects of preoperative major depression disorder (MDD) on in-hospital outcomes following CABG.

Methods: Patients who underwent CABG were identified in National Inpatient Sample from the last quarter of 2015 to 2020. Patients were stratified based on the diagnosis of MDD, followed by a 1:3 propensity-score matching of demographics, socioeconomic status, comorbidities, relevant diagnosis, admission status, and hospital characteristics between MDD and non-MDD patients. In-hospital perioperative outcomes, total length of stay (LOS), time from admission to operation, and total hospital charge were compared.

Results: There were 908 patients with MDD and 170,830 patients without MDD who underwent CABG. After propensity-score matching, 2,796 non-MDD were matched with all 908 MDD patients. While MDD patients have no difference in-hospital mortality or MACE, they had higher hemorrhage/hematoma (65.97 % vs 60.17 %, p < 0.01) and pacemaker implantation (2.53 % vs 1.43 %, p = 0.04). MDD patients had longer time from admission to operation (3.2 ± 0.1 vs 2.6 ± 0.2 days, p < 0.01), longer total LOS (12.6 ± 0.5 vs 10.5 ± 0.2 days, p < 0.01), and higher total hospital charge (272,255.0 ± 8930.1 vs 230,133.0 ± 3861.1 US dollars, p < 0.01).

Conclusion: Potential barriers could exist for MDD patients seeking access to CABG. Preoperative MDD is a risk factor for complications following CABG including hemorrhage/hematoma and pacemaker implantation. Enhanced attention to coagulation function is advisable for MDD patients prior to CABG.

Background: Allopurinol, a xanthine oxidase inhibitor, recovers histological alterations and renal dysfunction induced during renal ischemic-reperfusion injury. This study investigated the cross-talk between the allopurinol and soluble Klotho.

Methods: Rats were randomly divided into three equal groups (n = 8 per group): The sham-operated group without renal ischemia, the BIR (bilateral ischemia-reperfusion) group which underwent renal ischemia, and BIR+Allo (allopurinol) group which was pretreated with allopurinol (100 mg/kg- gavage) 30 min before the renal ischemia. After recovery from the anesthesia, all animals were placed in metabolic cages to collect their urine after 24 h, plasma was extracted from blood samples taken from the tail vein-plasma and urine samples were saved at -20 °C. Kidneys were harvested and weighed. The left kidney was dropped in the buffer of 10 % formalin for H&E staining, and the right kidney was located in liquid nitrogen and saved at -80 °C for the oxidative stress analysis.

Results: After renal ischemia-reperfusion, serum creatinine, blood urea nitrogen, xanthine oxidase, and total oxidative stress levels significantly increased. However, plasma Klotho level and total antioxidative capacity decreased in the BIR group. There was a reverse correlation between Klotho and xanthine oxidase levels. The pre-treatment with allopurinol increased plasma Klotho, induced a protective effect on renal histopathological changes, and corrected functional biomarkers.

Conclusion: Our results showed that allopurinol enhanced the antioxidative effects by increasing Klotho activity. Therefore, Klotho may be involved in the protective effects of allopurinol on the renal injury induced by BIR.

Purpose: This study aimed to explore the factors influencing the relapse of sputum-positive pulmonary tuberculosis (TB) in elderly patients with diabetes.

Methods: A total of 187 elderly patients with pulmonary tuberculosis (TB) and bacteriological relapse were selected as participants. These patients were divided into two groups: the TB group (82 cases, TB alone) and the combined group (70 cases, TB complicated with diabetes). Additionally, 90 elderly healthy individuals were enrolled in the healthy group. General data, glycosylated hemoglobin (HbA1c), and fasting blood glucose (FBG) levels were collected from all patients, and sputum smears were analyzed.

Results: The combined group exhibited worse outcomes in terms of diabetes duration, lobe cavity, and lesion area compared to the TB group (P < 0.05). Before treatment, the levels of HbA1c and FBG in the combined group were significantly higher than those in the TB group (P < 0.05). After treatment, both groups showed reduced levels of HbA1c and FBG, but the levels remained higher in the combined group compared to the TB group (P < 0.05). Single-factor Logistic regression analysis revealed that the risk factors for TB-positive relapse in diabetes patients complicated with TB included age, diabetes duration, lobe cavity, lesion range, HbA1c, and FBG. Moreover, multivariate Logistic regression analysis identified diabetes duration, lung lobe cavity, lesion area, HbA1c, and FBG as significant risk factors for TB-positive relapse in these patients.

Conclusion: Our study revealed that the risk factors for the relapse of sputum-positive TB in elderly diabetes patients include diabetes duration, lobe cavity, lesion area, HbA1c, and FBG.

Background: This review aims to analyze sex-related differences in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).

Methods: 10 studies were retrieved from PubMed and Embase comparing outcomes between men and women admitted with AMI complicated by CS. Pooled log odds ratios (OR) were calculated for binary outcomes using the Mantel-Haenszel method, and Hedges' g with the inverse-variance method was used for continuous outcomes.

Results: The primary endpoints were in-hospital mortality and 30-day mortality. The secondary endpoints were reinfarction rate, length of hospital stay (LOS), requirement of renal replacement therapy (RRT), and stroke (ischemic and hemorrhagic). Males exhibited a lower risk of in-hospital mortality (OR 0.77, 95 % CI 0.69-0.85, I² = 97 %, p < 0.0001), 30-day mortality (OR 0.69, 95 % CI: 0.61-0.78, I² = 0 %, p < 0.0001) and stroke (OR 0.91, 95 % CI 0.87-0.95, I² = 36 %, p < 0.0001) compared to females. In contrast, males were more likely to require renal replacement therapy (RRT) (OR 1.27, 95 % CI 1.09-1.48, I² = 69 % p = 0.0017). However, there were no statistically significant differences between females and males in terms of reinfarction rate (OR 0.88, 95 % CI 0.66-1.18, I² = 56 %, p = 0.3936) or length of hospital stay during hospitalization (Hedges's g 0.35 days, 95 % CI -0.38-1.07, I² = 100 %, p = 0.34).

Conclusion: Females with AMI and CS have higher in-hospital mortality, 30-day mortality, and stroke risk than men. Men are more likely to require RRT. Further research is needed to understand underlying mechanisms and improve outcomes for both genders.